The Very Ugly Side Of Pelvic Inflamatory Disease

Pelvic inflammatory disease or pelvic inflammatory disorder (PID) is an infection of the upper part of the female reproductive system (uterus, fallopian tubes), or the ovaries.
Often there may be no symptoms. Signs and symptoms, when present may include: lower abdominal pain, vaginal discharge, temperature, fever, burning with urination, painful sex, or irregular menstruation.

Untreated PID can result in long term complications including: infertility, ectopic pregnancy, chronic pelvic pain, and cancer.



Infections by Neisseria gonorrhoeae or Chlamydia trachomatis are present in 75 to 90 percent of cases.

Without treatment about 10% of those with a chlamydial infection and 40% of those with a gonorrhea infection will develop PID. Risk factors are similar to those of sexually transmitted infections generally and include a high number of sexual partners and drug use.

Vaginal douching may also increase the risk. The diagnosis is typically based on the presenting signs and symptoms. It is recommended that the disease be considered in all women of childbearing age who have lower abdominal pain.

A definitive diagnosis of PID is made by finding pus involving the fallopian tubes during surgery. Ultrasound may also be useful in diagnosis.


Efforts to prevent the disease include: not having sex or having few sexual partners and using condoms. Screening women at-risk for chlamydial infection followed by treatment decreases the risk of PID.

If the diagnosis is suspected, treatment is typically advised. Treating a woman's sexual partners should also occur. In those with mild or moderate symptoms a single injection of the antibiotic ceftriaxone along with 2 weeks of doxycycline and possibly metronidazole by mouth is recommended. For those who do not improve after three days or who have severe disease intravenous antibiotics should be used.


Worldwide, about 106 million cases of chlamydia and 106 million cases of gonorrhea occurred in 2008. The number of cases of PID however, is not clear.

It is estimated to affect about 1.5% of young women yearly. In the United States PID is estimated to affect about one million people yearly. A type of intrauterine device (IUD) known as the Dalkon shield led to increased rates of PID in the 1970s. Current IUDs are not associated with this problem after the first month.

Signs and symptoms

Symptoms in PID range from none to severe. If there are symptoms, then fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, uterine tenderness, adnexal tenderness, or irregular menstruation may be noted.
Other complications include: endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis, periappendicitis, and perihepatitis.

Cause

Chlamydia trachomatis and Neisseria gonorrhoeae are usually the main cause of PID. Data suggest that PID is often polymicrobial. Isolated anaerobes and facultative microorganisms have been obtained from the upper genital tract. N. gonorrhoeae has been isolated from fallopian tubes, facultative and anaerobic organisms were recovered from endometrial tissues.

The anatomical structure of the internal organs and tissues of the female reproductive tract provides a pathway for pathogens to enter the pelvic cavity thorough the infundibulum. The disturbance of the naturally occurring microbiota of the female genital tract increases the risk of PID^.
N. gonorrhoea and C. trachomatis are the most common organisms.

The least common were infections caused exclusively by anaerobes and facultative organisms. Anaerobes and facultative bacteria were also isolated from 50% of the patients from whom Chlamydia and Neisseria were recovered; thus, anaerobes and facultative bacteria were present in the upper genital tract of nearly two-thirds of the PID patients.

PCR and serological tests have associated extremely fastidious organism with endometritis, PID, and tubal factor infertility. Bacterial phylotypes and microbiotas now associated with PID and bacterial vaginosis are listed below.

Prevention

Regular sexually transmitted infections testing is important for prevention. The risk of contracting pelvic inflammatory disease can be reduced by the following:

• Using barrier methods such as condoms; see human sexual behavior for other listings.
• Seeking medical attention if you are experiencing symptoms of PID.
• Using hormonal combined contraceptive pills also helps in reducing the chances of PID by thickening the cervical mucosal plug & hence preventing the assent of causative organisms from the lower genital tracts.
• Seeking medical attention after learning that a current or former sex partner has, or might have had a sexually transmitted infection.
• Getting a STI history from your current partner and insisting they be tested and treated before intercourse.
• Diligence in avoiding vaginal activity, particularly intercourse, after the end of a pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures, to ensure that the cervix closes.
• Abstinence

Treatment

Treatment is often started without confirmation of infection because of the serious complications that may result from delayed treatment. Treatment depends on the infectious agent and generally involves the use of antibiotic therapy.

If there is no improvement within two to three days, the patient is typically advised to seek further medical attention. Hospitalization sometimes becomes necessary if there are other complications. Treating sexual partners for possible STIs can help in treatment and prevention.
The CDC guidelines state that the site route of antibiotic administration affects the short or long-term major outcome of women with mild or moderate disease.
For women with PID of mild to moderate severity, parenteral and oral therapies appear to be efficacious. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24–48 hours of clinical improvement. Typical regimens include cefoxitin or cefotetan plus doxycycline, and clindamycin plus gentamicin. An alternative parenteral regimen is ampicillin/sulbactam plus doxycycline. Another alternative is to use a parenteral regimen with ceftriaxone or cefoxitin plus doxycycline.

Complications

PID can cause scarring inside the reproductive system, which can later cause serious complications, including chronic pelvic pain, infertility, ectopic pregnancy (the leading cause of pregnancy-related deaths in adult females), and other complications of pregnancy. Occasionally, the infection can spread to in the peritoneum causing inflammation and the formation of scar tissue on the external surface of the liver (Fitz-Hugh-Curtis syndrome).
Fertility may be restored in women affected by PID with tuboplastic surgery. In vitro fertilization (IVF) has been used to bypass tubal problems and is successful resulting in higher delivery rates.